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INFLAMMATION OF THE GUT Flashcards

1
Q

what is the histology of the small intestine?

A

columnar epithelium with goblet cells and enterocytes. Paneth cells sit at the base of crypts. There are intraepthelial lymphocytes, peyers patches and Brunners glands (only in duodenum)

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2
Q

whats the function of paneth cells?

A

they contain eosinophilic lysozyme-rich granules so probably regulate cell proliferation and differentiation

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3
Q

what is the function of Peyer’s patches?

A

immune surveillance of materials within your digestive system

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4
Q

what is the function of Brunners glands in the duodenum?

A

secrete mucus with an alkaline pH, which serves to neutralize chyme from the stomach.

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5
Q

whats the histology of the large intestine?

A

Simple columnar epithelium lines its mucosa. The crypts of Lieberkühn are deeper in the colon and goblet cells become more abundant.
there are no villi, plicae circularis, or Paneth cells

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6
Q

what are the 5 layers of the digestive tract?

A 
mucosa
submucosa
muscular layer
subserosa - outside muscle coat mostly fat
serosa - shiny layer of peritoneum
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7
Q

what are some abdominal symptoms?

A

change in bowel habit
pain and discomofrt
wind
distention

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8
Q

what is diarrhoea?

A

an intestinal disorder characterised by an abnormal frequency and liquidity of faecal evacuations

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9
Q

how many children a year will get a diarrhoeal illness?

A

3-20%

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10
Q

what are the main causes of diarrhoea in developed countries?

A

IBS
IBD
malabsorption syndromes
chronic infections

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11
Q

what are the main causes of diarrhoea in developing countries?

A

bacteria
mycobacteria
parasites

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12
Q

what is secretory diarrhoea>

A

an increase in active secretion or inhibition of absorption e.g. cholera

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13
Q

what is osmotic diarrhoea?

A

too much water drawn into the bowels

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14
Q

what is exudative diarrhoea?

A

blood and pus in stool e.g. E.coli

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15
Q

what is inflammatory diarrhoea?

A

damage to the mucosal lining/brush border = loss of fluids and decreased ability to absorb

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16
Q

what is dysentry?

A

infection of the intestines that causes diarrhoea containing blood and mucus

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17
Q

whats the main causative organism of dysentry?

A

shigella

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18
Q

what are some consequences of diarrhoea?

A 
nutritional deficiencies e.g. anaemia, bleeding, bone disease
anorexia
weight loss
fatigue
oedema from protein deficiency
dehydration
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19
Q

why can diarrhoea cause anaemia?

A

iron, folate and B12 malabsorption

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20
Q

why can diarrhoea cause bleeding?

A

a vitamin K deficiency due to malabsorption of fat

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21
Q

why can diarrhoea cause bone diseases?

A

vitamin D and calcium deficiencies

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22
Q

what is coealiac disease?

A

an immunologically mediated inflammatory disorder due to the intolerance of gluten in genertically susceptible individuals

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23
Q

what genes have a strong association with coealiac diseases?

A

HLA-DQ2 mostly

some HLA-DQ8

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24
Q

when does coeliac disease typically begin?

A

childhood normally

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25
where has the highest incidence of coeliac disease?
Ireland!
26
why does ireland have a high coesliac disease incidence?
as an irish diet is typically low in gluten
27
how does incidence in men vs women occur in coeliac disease?
women: males 2:1
28
what are the risk factors for coeliac disease?
``` FHx autoimmune thyroid disease type 1 diabetes IgA deficiency Irritable bowel disorder ```
29
what are the 3 factors that cause coeliac disease?
genetic susceptibility sensitivity to gliadin environmental factors e.g. viral infection
30
what foods are gluten found in?
Barley Rye oats Wheat
31
what is gliadin?
a class of proteins/gluten peptides present within the grass genus Triticum
32
why are gluten peptides not completely broken down by digestive enzymes in the stomach?
gluten peptides are rich in proline and glutamine which prevents the totoal digestion, allowing gluten peptides to reach the small intestine
33
outline the pathophysiology of coealiac disease?
gluten proteins enter the small intestine and cross gut epithelial cells. here tissue transglutaminase cuts off an amide group converting it to deamidated gluten proteins. These are taken up by APCs and served on MHC class 2 molecules coded for by specific HLA genes. CD4+ T cells recognise gliadin as foreign and start pumping out IgA antibodies against gliadin and tissue transglutaminase. They also recruit CD8+ T cells which destroy tissue and cause inflammation
34
what is the endomysium?
a delicate network of connective tissue, which surrounds individual muscle fibres
35
what structural changes does coeliac disease cause in the small bowel?
villous atrophy crypt hyperplasia increase in lymphocytes in lamina propria cell death/tissue destruction
36
what are the consequences of coeliac disease?
malabsorption - anaemia, weight loss, failure to thrive, steatorrhoea malignancies osteoporosis neuropathies
37
what malignancies can coeliac disease cause?
enteropathy-associated T cell lymphoma Non-hodgkin lymphoma adenocarcinoma
38
how does coeliac disease usually present?
weight loss chronic diarrhoea anaemia failure to thrive may have abdo pain, altered bowel habits, bad smelling stool, bloating, depression, infertility
39
what is dermatitis herpetiformis?
chronic, intensely itchy, blistering skin manifestation of celiac diseas
40
how do we diagnosis coeliac disease?
SEROLOGY - TISSUE TRANSGLUTAMINASE ANTIBODIES, DEAMINATED GLIADIN PEPTIDE ANTIBODY AND ENDOMYCIUM ANTIBODY FBC - detect anaemia and infections endoscopy/tissue biopsy
41
how do you treat coeliac disease?
gluten-free diet | supplements if malabsorption is causing deficincies
42
what isa coeliac crisis?
a rare, life-threatening condiiton with unexplained diarrhoea, severe malabsorption and massive electrolyte imbalance
43
how do we manage a coeliac crisis?
rehydration, electrolytes and corticosteroids to reduce inflammtion.
44
what are soem differentials for coeliac disease?
``` cow milk sensitivity food-sensitive enteropathies crohns disease colitis whipples disease GIT lymphoma IBS ```
45
what is inflammatory bowel disease?
umbrella term to describe crohns disease and ulcerative colitis which vith cause inflammation of the GIT
46
what is the average age for IBD to present?
15-40
47
what mutations is crohns disease associated with?
NOD2 and IL-23
48
what expresses NOD2?
paneth cells of the gut
49
what is ulcerative colitis?
chronic inflammation in the mucosal layer of the GIT. Inflammation begins at the rectum and moves retrogradely through the colon
50
what is ulcerative proctitis?
ulcerative colitis only in the rectum
51
what is proctosigmoiditis?
ulcerative colitis in the rectum and sigmoid colon
52
what is extensive colitis?
ulcerative colitis in the rectum, sigmoid and colon up to the splenic flexure
53
what is pancolitis?
ulcerative colitis of the entire colon, including the caecum
54
how does the onset of symptoms occur in ulcerative colitis?
slow and gradual, progressing over a few weeks
55
what are the main symptoms of ulcerative colitis?
rectal bleeding diarrhoea general malais
56
what are some extraintestinal manifestations of IBD?
arthritis, uveitis, episcleritis, pyoderma grangrenosum, erythema nodosum, primary sclerosing cholangitis and thromboembolism
57
what are some acute complicatons of ulcerative colitis?
severe GI bleeds, fulminant colitis, toxic megacolon
58
what are long term complications of ulcerative colitis?
colorectal cancer severe dehydration a perforated colon bone loss
59
outline what the mucosa looks like in ulcerative colitis?
``` superficial ulceration (within the mucosa) that is continuous throughout an entire section. mucosa is friable to touch and can spontaneously bleed damage is limited to mucosa and submucosa ```
60
outline what the mucosa looks like in crohns disease?
muscle hypertrophy, fissures, cobblestone appearance, deep ulcerations damage is transmural and extends from mouth-anus
61
what are the main symptoms of crohns disease?
crampy abdo pain general malaise mucus and pus (steatorrhoea)
62
what is a fistula?
an abnormal connection or passageway that connects two organs or vessels that do not usually connect
63
how can the oral involveemnt of crohns disease present?
aphthous ulcers (canker sores), gingivitis and dysphagia
64
which disease in IBD is more likely to cause kidney and gallstones?
crohns disease
65
which disease of IBD has granuloma presence?
crohns disease
66
what is fecal caprotectin?
a protein released in large amounts by neutrophils in the GI tract during inflammation
67
what is mild ulcerative colitis?
<4 stools per day with or without blood with mild crampy abdo pain and occasional tenesmus
68
what is tenesmus?
the feeling that you need to pass stools, even though your bowels are already empty
69
what is moderate ulcerative colitis?
5 bloody stools per day, abdo pain, mild anaemia and somtimes a low grade fever
70
what is severe ulcerative colitis?
6 or more bloody stools per day with severe abdo pain, fever, tachycardia, anaemia, elevated ESR and weight loss
71
how do we treat ulcerative colitis?
aminosalicylates, corticosteroids
72
what does the Crohns disease activity indec measure?
``` stool pattern general daily well-being over 7 days complications presence of abdominal mass anaemia weight changes ```
73
how do we treat crohns?
``` no cure but can control symptoms! corticosteroids liquid diet immunosupressants biologics surgery dont take NSAIDs ```
74
how does smoking affect prevalence of ulcerative colitis?
prevalenc of UC is less in smokers than in non-smokers
75
what are the main susbtrate deficiencies in coeliac disease?
iron, folate and vit D and calcium

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